The Management of Perforated Diverticulitis With Diffuse Peritonitis

Theile, David E.

doi:10.1111/j.1445-2197.1980.tb04490.x

Cited by 6 publications

References 14 publications

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Emergency surgery for diverticular disease complicated by generalized and faecal peritonitis: A review

Krukowski

Matheson

1984

Journal of British Surgery

268

128

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There is little uniformity in either the indications for operation, the classification of the pathology or the operative management of generalized or faecal peritonitis secondary to perforated diverticular disease. Nevertheless, this review has shown a clear advantage both in terms of immediate mortality and morbidity for primary resection over conservative operations in which the colon is retained in the abdomen. We propose that, when a clinical diagnosis of localized sepsis secondary to diverticular disease is made, the management should be nonoperative with systemic antibiotics and supportive therapy. Operation should be reserved for those patients with obvious generalized peritonitis or failure of conservative treatment. When operation is necessary the affected sigmoid loop should be resected and the operation completed as a Hartmann's procedure in all but the most favourable circumstances when a primary anastomosis may be considered after on-table irrigation of the colon.

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Emergency surgery for diverticular disease complicated by generalized and faecal peritonitis: A review

Krukowski

Matheson

1984

Journal of British Surgery

268

128

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Primary resection and anastomosis for treatment of acute diverticulitis

Alanis¹,

Papanicolaou²,

Tadros³

et al. 1989

Diseases of the Colon &Amp; Rectum

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The patterns of presentation and associated treatments of 65 patients with acute perforated diverticulitis of the left colon have been reviewed. Four types of operations were identified: primary resection with anastomosis (group I, N = 29), primary resection with anastomosis and protective colostomy (group II, N = 5), primary resection with Hartmann procedure (group III, N = 26), and delayed resection three-staged procedure (group IV, N = 5). The severity of disease was also classified (stages I to IV). Postoperative mortality rates in the first two groups were lower than that of the Hartmann group (3.4 vs. 15.3 percent). The mean length of initial hospitalization was 16 +/- 1.2 days for group I, 18.2 +/- 4.4 days for group II, 19.4 +/- 2 days for group III, 26.4 +/- 4.4 days for group IV (P less than .05, t-test group IV vs. groups I, II, and III). Complications in the Hartmann group were high with a 23 percent wound infection rate and mortality after closure of colostomy and bowel reconstruction was 3.8 percent. These data demonstrate that primary resection with anastomosis is a satisfactory operation for the majority of patients with perforated diverticulitis (stages I to III), and there appears to be no clinical indication to use the three-staged operation.

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A comparison of emergency resection and staged management in perforated diverticular disease

Finlay

Carter

1987

Diseases of the Colon &Amp; Rectum

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This retrospective view examines the outcome of surgical treatment of perforated diverticular disease in one hospital in the period 1976 to 1983. Of the 78 patients, 38 underwent emergency colonic resection (group A) whereas 40 (group b) were treated by proximal colostomy and drainage (37 patients) or suture of the perforation with drainage (three patients). There was no significant difference between groups A and B in terms of operative mortality (21 percent vs. 24 percent, respectively). Mortality rates were highest in patients with generalized peritonitis treated by colostomy and drainage (36 percent), whereas those with localized disease undergoing resection had a mortality rate of 17 percent (P less than .05). Eight of the 40 patients in group B developed fistulas whereas none of the group A patients had this complication. Only four (16 percent) of the surviving group A patients were left with a permanent colostomy as opposed to 15 (56 percent) of their counterparts in group B. In the presence of perforated diverticular disease, emergency resection carries a lower morbidity than colostomy and drainage, although the present review shows no statistically significant differences in terms of mortality.

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The Management of Perforated Diverticulitis With Diffuse Peritonitis

Cited by 6 publications

References 14 publications

Emergency surgery for diverticular disease complicated by generalized and faecal peritonitis: A review

Emergency surgery for diverticular disease complicated by generalized and faecal peritonitis: A review

Primary resection and anastomosis for treatment of acute diverticulitis

A comparison of emergency resection and staged management in perforated diverticular disease

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